Inaccurate quality reports could skew EHR incentives: study

Electronically reported clinical quality measures vary widely in accuracy, an obstacle that could hinder the federal government's electronic health-record incentive program, according to a study appearing in the Annals of Internal Medicine.

The problem could lead to the highest quality providers not being given the intended incentives, the study concluded.

Beginning in 2014, participants in the CMS' EHR incentive program will be required to report quality data via EHRs. Currently, most quality-reporting initiatives rely on administrative billing data, which has drawn criticism for a lack of clinical relevance, or manual record review, which is time-consuming. Many experts have pointed to EHR-extracted quality data as the best representation of actual patient care.

But researchers, using 2008 data from more than 1,100 patients treated at a federally qualified health center, found big gaps in sensitivity from one electronic measure to another. For instance, electronic measures significantly underestimated the health center's rates of pneumococcal vaccinations and appropriate use of asthma medication, when compared with manual record review.

The authors recommended greater use of structured fields in EHRs as a way to boost accuracy. They also called for better measures designed specifically for electronic reporting.

“If electronic reports are not proven to be accurate, their ability to change physicians' behavior to achieve higher quality, the underlying goal, will be undermined,” they said in the study.

The study examined 12 electronically reported measures, 11 of which overlap with the 44 Stage 1 meaningful-use measures, and 10 of which overlap with Stage 2's measures.